Radial Artery Grafting in Women Improves 15-Year Survival

OBJECTIVES:

Radial artery (RA) grafting has a clear survival
advantage after coronary artery bypass grafting (CABG) in studies with
predominantly male populations, but the impact on women’s long-term
survival is unclear. We sought to determine if the reported long-term
survival benefit of RA versus saphenous vein (SV) grafting in the
general CABG population is valid for women.

METHODS:

Between 1995 and 2010, 1339 female patients were alive 30 days after primary, isolated CABG with left internal thoracic
artery (LITA) and additional RA or SV conduits as needed. Patients were
evaluated based on RA use: 332 patients had RA and 1007 patients had
SV. Of these, 283 RA patients were matched to SV counterparts using a
nonparsimonious propensity model based on 45 patient variables.

RESULTS:

Kaplan-Meier
estimated survivals for the matched RA women at 1, 5, 10, and 15 years
were 99%, 93%, 80%, and 70% versus 97%, 87%, 72%, and 58% for the SV
women (log rank, P = .018). For symptomatic patients, overall RA patency
was 80%, which was not different from the LITA patency rate of 84% but
was superior to the SV conduits patency rate of 56% (P < .001).

CONCLUSIONS:

In women undergoing CABG with LITA grafting, use of an RA graft improves survival compared with use of an SV graft.